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Pathologizing the norm: Follow-up

For those of you who are interested in this debate, there’s a great new two-part article in the New York Review of Books by Marcia Angell questioning “The Epidemic of Mental Illness.” The articles summarize three new books that are concerned about the prescription frenzy we are in the midst of and how this reliance on psychoactive medication came to be. She addresses the problem of dealing with psychiatric disorders as chemical imbalances and the dubious efficacy these drugs have in actually improving symptoms.

I highly recommend this read, as well as the second part in the series on “The Illusions of Psychiatry” for anyone concerned about our mental health system. One of the most resounding points she makes in the second piece is the perpetual expansion of the diagnoses listed in the American Psychological Association’s Diagnostics and Statistical Manual (DSM). With every publication of the DSM, there are more and more behaviors we have pathologized and “disorders” we have created, and with the upcoming publication of the DSM-V, there will certainly be a slew of new problems that we can put a name to and claim for ourselves. Angell succinctly describes this problem, stating, “Unlike the conditions treated in most other branches of medicine, there are no objective signs or tests for mental illness—no lab data or MRI findings—and the boundaries between normal and abnormal are often unclear. That makes it possible to expand diagnostic boundaries or even create new diagnoses, in ways that would be impossible, say, in a field like cardiology.”

Finally, she brings to task the drug companies who are more involved in psychiatric treatment than in any other medical field. This applies not only to clinicians and psychiatrists with private practices, but also the research institutions, hospitals, universities, policy makers, patient advocacy groups, educational organizations, and the APA itself.

Angell’s writing takes a good, hard look at the system of mental health, and while at times she makes some uncomfortable points, they are important issues that need to be addressed.